- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $7,244.36 / $13,489.63
| Facility | | $1,513.56 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $2,041.74 / $4,570.88
| Professional | | $794.33 | $2,041.74 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $10,000.00 / $57,543.99
| Facility | | $9,549.93 | $10,000.00 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54,954.09 / $64,565.42 / $64,565.42
| Professional | | $54,954.09 | $64,565.42 | $64,565.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $870.96
| Facility | | $489.78 | $575.44 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $1,513.56
| Professional | | $1,513.56 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $14,125.38 / $26,302.68
| Facility | | $3,981.07 | $14,125.38 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $933.25 / $1,584.89
| Professional | | $758.58 | $933.25 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $6,165.95 / $13,489.63
| Facility | | $1,023.29 | $6,165.95 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $2,187.76 / $5,248.07
| Professional | | $660.69 | $2,187.76 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.46 / $14.45 / $32.36
| Facility | | $6.46 | $14.45 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $14.45 / $32.36
| Professional | | $6.46 | $14.45 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,168.69 / $17,782.79
| Facility | | $1,584.89 | $4,168.69 | $17,782.79 |